This Viewpoint, published in Lancet by David Matthew Doyle and Annelou L C de Vries, addresses how systematic reviews have been used to summarise evidence on medical interventions for adolescents who are transgender, gender diverse, or non-binary. The authors define adolescent care in this context as interventions started from the onset of puberty until 18 years of age. They note that gender-affirming medical treatment in adolescence has become increasingly contested and that systematic reviews carry considerable influence because they are regarded as high-quality sources of empirical evidence within evidence-based medicine.
The authors report that 13 systematic reviews have been conducted since 2017, with seven published since 2023. These reviews have examined potential effects of puberty suppression and gender-affirming hormone therapy on outcomes including psychosocial well-being, cognition, and physical health in adolescents. The Viewpoint characterises these reviews as central inputs into debates about efficacy and safety of medical gender-affirming interventions for young people. The abstract does not present granular data from the individual reviews, such as effect sizes, sample sizes, or risk-of-bias assessments, so such details are not reproduced here.
Because systematic reviews are perceived as the highest tier of empirical knowledge in evidence-based medicine, their conclusions can have broad consequences. The authors emphasise that the content and interpretation of these reviews influence government and health-care policies, clinical practice, and public discussion. They raise concern that reviews may be misused to steer treatment options and care pathways in ways that do not fully reflect the totality of clinical evidence, clinical expertise, or patient values. The Viewpoint therefore highlights the societal and political dimensions of how evidence summaries are produced and applied.
Doyle and de Vries argue that clinical guideline development should be underpinned by all three pillars of evidence-based medicine: empirical evidence, clinical expertise, and patient values. They assert that evaluation by field experts is necessary to ensure balanced guidance. The Viewpoint positions comprehensive appraisal—incorporating systematic review findings alongside expert clinical judgment and patient perspectives—as essential for forming recommendations about puberty suppression and gender-affirming hormone therapy for adolescents. The abstract does not list specific guideline recommendations or procedural steps but emphasises the triad approach as a principled foundation.
Both authors are affiliated with Amsterdam University Medical Center and the Center of Expertise on Gender Dysphoria at Vrije Universiteit Amsterdam. The article includes a detailed declaration of interests. DMD reports funding from the European Commission via the European Research Council, Marie Skłodowska-Curie Actions, and the Dutch Research Council; support for invited keynotes and travel from professional organisations; fees for grant evaluation; participation on an external scientific advisory board; and unpaid leadership in a public health association. ALCdV reports funding from the Dutch Research Council via the Talentprogramme Vici, support for invited keynotes and travel from multiple organisations, payment for expert testimony, and unpaid leadership roles including EPATH and liaison roles with the World Professional Association for Transgender Health. These declarations are presented as interests external to the Viewpoint.
The Viewpoint concludes by drawing attention to the powerful role systematic reviews play in shaping policy and clinical practice concerning adolescent gender-affirming care. The authors caution against misuse of review findings to unduly constrain treatment options or alter care pathways without consideration of the full evidence ecosystem. They advocate that guideline development should integrate empirical evidence, clinical expertise, and patient values, and should be evaluated by experts in the field. The abstract does not provide specific clinical recommendations or quantitative summaries of harms and benefits; such details were not reported in the abstract and therefore are not included in this rewrite.
Publication details: Lancet. 2026 Aug 29;408(10557):861-866. DOI: 10.1016/S0140-6736(26)00788-9. PMID: 42660154.
MeSH terms assigned to the article include Adolescent, Evidence-Based Medicine, Gender-Affirming Care, Puberty Suppression, Transgender Persons, Health Policy, and Politics, reflecting its combined clinical and policy focus.